Take the Time: Post operative care for the Inpatient

Thornbrugh, Jenifer M

Saturday, 16 November 2013

Jenifer M Thornbrugh, Rn, BSN
Nursing Department, Veterans Health Care System of the Ozarks, Fayetteville, AR

Learning Objective 1: Describe evidence regarding post operative assessment

Learning Objective 2: Determine the importance of standardizing post operative assessment

Veterans Health Care System of the Ozarks (VHSO) performs an average of 1,200 surgical cases per year that require general anesthesia. An average of 15 surgical cases per month requires admission for post operative care. Chart reviews revealed that no definitive policy existed regarding post operative inpatient assessments. Vital signs and post operative assessments were inconsistent. PICO: Does implementing a standard of care on nursing assessments and/or frequency of vital signs decrease the required level of care after unanticipated complications in the patients post general anesthesia?

Electronic search was conducted via EBSCOhost Web and the Veterans Integrated Service Network (VISN 16) comprehensive medical library. Articles were selected based on linkage between post operative assessment and changes in level of care. There were no Level 1 studies and only five articles met criteria for inclusion into the summary. The literature did note that hypoxemia in the immediate 24 hours following administration of anesthesia agents could impact patient outcomes adversely. Proposal: To standardize the management of the post operative patient across the continuum of care, policy changes are proposed. These assessments will be charted electronically in an existing vital signs software package. The standardized post operative process will include assessment upon arrival, then every 30 minutes x 2, every hour x 2, and as ordered. Assessment will include bedside pulse oximetry measurement.

In addition to unit based champions, the change will be marketed as “Take the Time”. The unit based vital signs machines will be fitted with pulse oximetry to promote ease of use. Outcomes: Expected outcomes include early detection of post operative complications and reduction in moves to higher levels of care.

Standardized post operative nursing assessments have the potential to improve nursing practice, patient outcomes and reduce the need for level of care changes secondary to unanticipated complications.

See more of: Evidence-Based Practice Posters Session 1
See more of: Oral Paper & Poster: Evidence-Based Practice Sessions